You are on page 1of 4

THE PUBLIC ACCOUNTANTS EXAMINATIONS BOARD

A Committee of the Council of ICPAU


P.O. BOX 12464, KAMPALA, TEL: 041-4540125/6, 031-2262333, FAX: 041-4540389

CPA(U) STUDENT REGISTRATION FORM


REG. NO.
REG. DATE:

Affix your
Passport size
Photograph here
(See Note2)

Before completing this form please read it carefully with the help of notes on page 4

1.0

GENERAL INFORMATION:

1.1

SURNAME: ...............................................................................................................................

1.2

OTHER NAMES: ......................................................................................................................

1.3

GENDER:

1.4

NATIONALITY: ......................................................................................................................

1.5

DATE OF BIRTH:

Male

Date

Month

Female

Year

1.6

ADDRESS

C/o

P.O. BOX

TOWN/ CITY :

COUNTRY

MOBILE TEL. :

OFFICE TEL. :

HOME TEL

FAX NO.

E-mail

1.7

PASSPORT NO. (See Note 4): ________________________________________________

2.0

Educational background (see Note 5)


Schools, Colleges,
Universities attended

Examining
Body

Date

Grade or
Certificate
Class
obtained awarded

2.1
2.2
2.3
2.4
2.5
2.6

3.0

EXEMPTIONS

3.1

I wish to apply for exemption from the following subjects of CPA(U) examinations:
Subject

Paper
Code

For Student's Use Only

Tick()

1.

Financial Accounting

2.

Economic Environment

3.

Business Law

4.

Business Management & Computing

5.

Quantitative Techniques

6.

Management Accounting & Finance

7.

Audit Theory

Signature

For ICPAU Official Use Only

Eligibility

Signature

FOR ICPAU OFFICIAL USE ONLY


3.2

Remarks by Approving Authority:

....................................................................................................................................................

....................................................................................................................................................

Name: ............................................. Signature: ................................ Date: ..........................

3.3

Payment:

Advised to pay Shs. .................................................... Amount paid. Shs. ............................

Received by: ..................................... Signature: ................................ Date: ........................


2

4.0

Employment record

4.1

Employment Record (Start with the current dates going backwards)

Name of Employer

Designation

From

To

4.2

Name of Current Organisation:

........................................................................................

Address:

................................................................................................................

................................................................................................................

................................................................................................................

................................................................................................................

Tel.:

....................................................

Employment Terms: Permanent

5.0

DECLARATION BY APPLICANT

5.1

I hereby declare that the information given in this form and in all the documents attached in

Part-time

E-mail: ...........................................

Others (Specify) ..................................

support hereof is true and correct. I hereby apply for registration as a student of ICPAU. If
registered, and so long as I remain a registered student of ICPAU, I undertake to observe and
abide by the Rules and Regulations of students, candidates and graduates which are now and
may hereafter be in force from time to time.
Cheque No........................

Bank draft ......................

Cash ..................

5.2

I enclose

in respect of Registration fee (see note 7) for Shs......................................................................

Signature: ............................................................ Date:.....................................................

6.0

Declaration by Referee (See Note 6.)

I certify that the above named has been employed by me/us or has been known to me

since ................................. (insert date) and that he/she is a fit and proper person to register as

a student of ICPAU, and that to the best of my/our knowledge the above information is correct.

Name:............................................................................

Designation: ...............................................................................................................................

Organisation: ............................................................................................................................

Address: .....................................................................................................................................

Tel. No.: ...............................................................

Stamp ........................................................................................................................................
3

Signature: .................................

E-mail: ....................................................

NOTES:
1.

Please complete the application form in CAPITAL LETTERS (in black or blue ink).

2.

Attach three coloured passport size photographs. One photo should be certified by your referee.
Instant photos are not acceptable.

3.

The names entered must agree with names on all supporting documents attached. Any change
must be supported by a legal document (e.g. Marriage certificate, Affidavit or Deed).

4.

If you have no passport insert NONE.

5.

Attach copies of academic transcripts and certificates. All attached documents must be certified
by your referee. Alternatively, the Institute can certify the academic documents if you present
the originals. Please do not send us original documents.

6.

The declaration by a referee must be made by a Chief Executive or Head of Department, Head of
an Educational Institute, a member of a reputable profession, or a high ranking civil servant.

7.

Cheques and/or Bank drafts drawn in Kampala banks should be made payable to Institute of
Certified Public Accountants of Uganda. Up-country cheques are not acceptable.

8.

Incomplete forms will be returned to the applicant.

FOR ICPAU OFFICIAL USE ONLY


1.

Registration:

(a)

Registration No. .............................. (b) Date of Registration:


Date

Accepted

Month

Year

(c)

Certificates:

Reason for rejection: ....................................................................................................................

Registration Official: Name: ......................................................... Signature ................................

2.

Approval:

Remarks ........................................................................................................................................

Approving official: Name: ...........................................................................................................

Signature ................................................................................... Date: .........................................

3.

Payment:

Receipt No................................ Amount: (UShs) ................................ Date............................

Received by ............................................................................ Signature .....................................

4.

Notification Sent by:

Name: ............................................... Signature ........................................... Date: ...................


4

Rejected